1. Is it feasible to implement a rapid recovery pathway for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion in a single-payer universal health care system?
- Author
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Paul J Moroz, Deborah Mervitz, Andrew Tice, Nick Barrowman, Zachary DeVries, James G. Jarvis, and Kevin Smit
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Canada ,Time Factors ,Adolescent ,medicine.medical_treatment ,Idiopathic scoliosis ,Scoliosis ,Interrupted Time Series Analysis ,03 medical and health sciences ,0302 clinical medicine ,Cost Savings ,Health care ,medicine ,Humans ,Orthopedics and Sports Medicine ,030222 orthopedics ,business.industry ,Age Factors ,Emergency department ,Recovery of Function ,Length of Stay ,medicine.disease ,Spine ,Spinal Fusion ,Spinal fusion ,Orthopedic surgery ,Critical Pathways ,Feasibility Studies ,Universal Health Care ,Female ,Complication ,business ,Delivery of Health Care ,030217 neurology & neurosurgery - Abstract
The purpose of this project was to determine if it is feasible to implement a rapid recovery pathway (RRP) for the surgical treatment of adolescent idiopathic scoliosis (AIS) within a single-payer universal healthcare system while simultaneously decreasing length of stay (LOS) without increasing post-operative complications. A retrospective analysis was completed for all patients who underwent posterior spinal fusion for AIS at a tertiary children’s hospital in Canada between March 2010 and February 2019, with date of implementation of the RRP being March 1st, 2015. Patient demographic information was collected along with a variety of outcome variables including: LOS, wound complication, infection, 30-day return to the OR, 30-day emergency department visit, and 30-day hospital readmission. An interrupted time series analysis was utilized to determine if any benefits were associated with the implementation of the RRP. A total of 244 patients were identified, with 113 patients in the conventional pathway and 131 in the RRP. No significant differences in demographic features or post-operative complications were found between the two cohorts (p > 0.05). Using a robust linear time series model, LOS was found to be significantly shorter in the RRP group, with the average LOS being 5.2 [95% IQR 4.3–6.1] days in the conventional group and 3.4 [95% IQR 3.3–3.5] days in the RRP group (p
- Published
- 2020